Is there a role for [18F]-FMISO PET to guide dose adaptive radiotherapy in head and neck cancer? A review of the literature

Khrishanthne Sambasivan; Sally F. Barrington; Steve E.J. Connor; Timothy H. Witney; Philip J. Blower; Teresa Guerrero Urbano

doi:10.1007/s40336-023-00607-y

Is there a role for [¹⁸F]-FMISO PET to guide dose adaptive radiotherapy in head and neck cancer? A review of the literature

Khrishanthne Sambasivan^*, Sally F. Barrington, Steve E.J. Connor, Timothy H. Witney, Philip J. Blower, Teresa Guerrero Urbano

^*Corresponding author for this work

Research output: Contribution to journal › Review article › peer-review

1 Citation (Scopus)

Abstract

Purpose: Hypoxia is a major cause of radioresistance in head and neck cancer (HNC), resulting in treatment failure and disease recurrence. ¹⁸F-fluoromisonidazole ([¹⁸F]FMISO) PET has been proposed as a means of localising intratumoural hypoxia in HNC so that radiotherapy can be specifically escalated in hypoxic regions. This concept may be challenging to implement in routine clinical practice however, given that [¹⁸F]FMISO PET is costly, time consuming and difficult to access. The aim of this review was to summarise clinical studies involving [¹⁸F]FMISO PET and to appraise the evidence for its role in guiding radiotherapy treatment in HNC. Methods: A comprehensive literature search was conducted on PubMed and Web of Science databases. Studies investigating [¹⁸F]FMISO PET in newly diagnosed HNC patients were considered eligible for review. Results: We found the following important results from our literature review: (1) Studies have demonstrated a correlation between [¹⁸F]FMISO PET and other hypoxia biomarkers, although the results are not consistent enough to propose a proxy biomarker of [¹⁸F]FMISO PET. (2) [¹⁸F]FMISO PET uptake changes during a course of radiotherapy treatment, suggesting that imaging should be repeated during treatment. (3) Tumour recurrences do not always occur within the pretreatment hypoxic volume on [¹⁸F]FMISO PET. (4) Dose modification studies using [¹⁸F]FMISO PET are in a pilot phase. Conclusions: Our results show that currently there is insufficient evidence to propose [¹⁸F]FMISO PET for radiotherapy dose adaptation in HNC in a routine clinical setting. Part of the challenge is that hypoxia is a dynamic phenomenon, and thus areas identified on a single scan may not be representative. At present, it is anticipated that [¹⁸F]FMISO PET will remain useful within the research setting only.

Original language	English
Pages (from-to)	137-155
Number of pages	19
Journal	Clinical and Translational Imaging
Volume	12
Issue number	2
DOIs	https://doi.org/10.1007/s40336-023-00607-y
Publication status	Published - Apr 2024

Keywords

Head and neck cancer
Hypoxia
[F]FMISO

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1007/s40336-023-00607-y

Cite this

@article{639165eb5a3e4d7bbf9372c8c0c8256b,

title = "Is there a role for [18F]-FMISO PET to guide dose adaptive radiotherapy in head and neck cancer? A review of the literature",

abstract = "Purpose: Hypoxia is a major cause of radioresistance in head and neck cancer (HNC), resulting in treatment failure and disease recurrence. 18F-fluoromisonidazole ([18F]FMISO) PET has been proposed as a means of localising intratumoural hypoxia in HNC so that radiotherapy can be specifically escalated in hypoxic regions. This concept may be challenging to implement in routine clinical practice however, given that [18F]FMISO PET is costly, time consuming and difficult to access. The aim of this review was to summarise clinical studies involving [18F]FMISO PET and to appraise the evidence for its role in guiding radiotherapy treatment in HNC. Methods: A comprehensive literature search was conducted on PubMed and Web of Science databases. Studies investigating [18F]FMISO PET in newly diagnosed HNC patients were considered eligible for review. Results: We found the following important results from our literature review: (1) Studies have demonstrated a correlation between [18F]FMISO PET and other hypoxia biomarkers, although the results are not consistent enough to propose a proxy biomarker of [18F]FMISO PET. (2) [18F]FMISO PET uptake changes during a course of radiotherapy treatment, suggesting that imaging should be repeated during treatment. (3) Tumour recurrences do not always occur within the pretreatment hypoxic volume on [18F]FMISO PET. (4) Dose modification studies using [18F]FMISO PET are in a pilot phase. Conclusions: Our results show that currently there is insufficient evidence to propose [18F]FMISO PET for radiotherapy dose adaptation in HNC in a routine clinical setting. Part of the challenge is that hypoxia is a dynamic phenomenon, and thus areas identified on a single scan may not be representative. At present, it is anticipated that [18F]FMISO PET will remain useful within the research setting only.",

keywords = "Head and neck cancer, Hypoxia, [F]FMISO",

author = "Khrishanthne Sambasivan and Barrington, {Sally F.} and Connor, {Steve E.J.} and Witney, {Timothy H.} and Blower, {Philip J.} and Urbano, {Teresa Guerrero}",

note = "Funding Information: For Professor Sally Barrington:This work was supported by the National Institute for Health and Care Research (NIHR) [RP-2016–07-001]. This work was also supported by core funding from the Wellcome/EPSRC Centre for Medical Engineering at King{\textquoteright}s College London [WT203148/Z/16/Z]. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. For Dr Tim Witney: Funding was provided through a Wellcome Trust Senior Research Fellowship (220,221/Z/20/Z). For Dr Teresa Guerrero Urbano: This work was supported by the Radiation Research Unit at the Cancer Research UK City of London Centre Award [C7893/A28990]. Publisher Copyright: {\textcopyright} 2024, The Author(s).",

year = "2024",

month = apr,

doi = "10.1007/s40336-023-00607-y",

language = "English",

volume = "12",

pages = "137--155",

journal = "Clinical and Translational Imaging",

issn = "2281-5872",

publisher = "Springer-Verlag Italia",

number = "2",

}

TY - JOUR

T1 - Is there a role for [18F]-FMISO PET to guide dose adaptive radiotherapy in head and neck cancer? A review of the literature

AU - Sambasivan, Khrishanthne

AU - Barrington, Sally F.

AU - Connor, Steve E.J.

AU - Witney, Timothy H.

AU - Blower, Philip J.

AU - Urbano, Teresa Guerrero

N1 - Funding Information: For Professor Sally Barrington:This work was supported by the National Institute for Health and Care Research (NIHR) [RP-2016–07-001]. This work was also supported by core funding from the Wellcome/EPSRC Centre for Medical Engineering at King’s College London [WT203148/Z/16/Z]. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. For Dr Tim Witney: Funding was provided through a Wellcome Trust Senior Research Fellowship (220,221/Z/20/Z). For Dr Teresa Guerrero Urbano: This work was supported by the Radiation Research Unit at the Cancer Research UK City of London Centre Award [C7893/A28990]. Publisher Copyright: © 2024, The Author(s).

PY - 2024/4

Y1 - 2024/4

N2 - Purpose: Hypoxia is a major cause of radioresistance in head and neck cancer (HNC), resulting in treatment failure and disease recurrence. 18F-fluoromisonidazole ([18F]FMISO) PET has been proposed as a means of localising intratumoural hypoxia in HNC so that radiotherapy can be specifically escalated in hypoxic regions. This concept may be challenging to implement in routine clinical practice however, given that [18F]FMISO PET is costly, time consuming and difficult to access. The aim of this review was to summarise clinical studies involving [18F]FMISO PET and to appraise the evidence for its role in guiding radiotherapy treatment in HNC. Methods: A comprehensive literature search was conducted on PubMed and Web of Science databases. Studies investigating [18F]FMISO PET in newly diagnosed HNC patients were considered eligible for review. Results: We found the following important results from our literature review: (1) Studies have demonstrated a correlation between [18F]FMISO PET and other hypoxia biomarkers, although the results are not consistent enough to propose a proxy biomarker of [18F]FMISO PET. (2) [18F]FMISO PET uptake changes during a course of radiotherapy treatment, suggesting that imaging should be repeated during treatment. (3) Tumour recurrences do not always occur within the pretreatment hypoxic volume on [18F]FMISO PET. (4) Dose modification studies using [18F]FMISO PET are in a pilot phase. Conclusions: Our results show that currently there is insufficient evidence to propose [18F]FMISO PET for radiotherapy dose adaptation in HNC in a routine clinical setting. Part of the challenge is that hypoxia is a dynamic phenomenon, and thus areas identified on a single scan may not be representative. At present, it is anticipated that [18F]FMISO PET will remain useful within the research setting only.

AB - Purpose: Hypoxia is a major cause of radioresistance in head and neck cancer (HNC), resulting in treatment failure and disease recurrence. 18F-fluoromisonidazole ([18F]FMISO) PET has been proposed as a means of localising intratumoural hypoxia in HNC so that radiotherapy can be specifically escalated in hypoxic regions. This concept may be challenging to implement in routine clinical practice however, given that [18F]FMISO PET is costly, time consuming and difficult to access. The aim of this review was to summarise clinical studies involving [18F]FMISO PET and to appraise the evidence for its role in guiding radiotherapy treatment in HNC. Methods: A comprehensive literature search was conducted on PubMed and Web of Science databases. Studies investigating [18F]FMISO PET in newly diagnosed HNC patients were considered eligible for review. Results: We found the following important results from our literature review: (1) Studies have demonstrated a correlation between [18F]FMISO PET and other hypoxia biomarkers, although the results are not consistent enough to propose a proxy biomarker of [18F]FMISO PET. (2) [18F]FMISO PET uptake changes during a course of radiotherapy treatment, suggesting that imaging should be repeated during treatment. (3) Tumour recurrences do not always occur within the pretreatment hypoxic volume on [18F]FMISO PET. (4) Dose modification studies using [18F]FMISO PET are in a pilot phase. Conclusions: Our results show that currently there is insufficient evidence to propose [18F]FMISO PET for radiotherapy dose adaptation in HNC in a routine clinical setting. Part of the challenge is that hypoxia is a dynamic phenomenon, and thus areas identified on a single scan may not be representative. At present, it is anticipated that [18F]FMISO PET will remain useful within the research setting only.

KW - Head and neck cancer

KW - Hypoxia

KW - [F]FMISO

UR - http://www.scopus.com/inward/record.url?scp=85182854800&partnerID=8YFLogxK

U2 - 10.1007/s40336-023-00607-y

DO - 10.1007/s40336-023-00607-y

M3 - Review article

AN - SCOPUS:85182854800

SN - 2281-5872

VL - 12

SP - 137

EP - 155

JO - Clinical and Translational Imaging

JF - Clinical and Translational Imaging

IS - 2

ER -